Air pollution, sworn adversary of healthy lungs

With the arrival of autumn, Delhi, the national capital, becomes a gas chamber containing highly polluted toxic air, with emissions from firecrackers and stubble burning adding fuel to the fire, and breathing the thick smog enveloping the lower atmosphere, which is full of harmful particles and gases, is enough to send shivers down the spine of those exposed. As usual, the sight and fury of contaminated air incites public outrage, and the government machinery awakens from its slumber to take some emergent steps to quell the outrage, but the rage of air pollution remains unabated. The repercussions of both acute and chronic pollution exposure are listed below.

Air pollution began the day man started exploiting nature and the industrial revolution, accelerated the process by the way of unregulated emissions from burning fossil fuel such as coal and oil, the major sources of energy and now the world is on the thresh hold of a major disaster with global health and well-being in a severe crisis, warranting urgent implementation of effective measures to curb the growing menace.

Air Pollution is a global phenomenon and as per WHO, 8.7 million died worldwide in the year 2019 that is exceeding the combined mortality due to smoking and malaria with India contributing 2. 5 million to the mortality figure and nearly 4 million deaths occur annually due to indoor air pollution alone.

Air pollution is a major cause of Chronic Obstructive Pulmonary Disease (COPD) which makes lungs weak and unhealthy and as one celebrates ‘World COPD Day’ on November 17 this year, one is made aware of this year’s theme “Healthy Lungs-Never More Important” that is aiming to highlight the burden of COPD, a leading cause death worldwide, even in the light of COVID-19 pandemic. There is no doubt that there is never a more important time than now to focus on lung health by preventive measures such as exercise, vaccination, avoiding pollution and smoking cessation since respiratory illnesses like COPD is man-made disaster and is eminently preventable and even treatable when detected at an early stage.

COPD is a progressive and debilitating disease that is characterized by persistent respiratory symptoms and airflow limitations that is due to abnormalities in the air way or air sacs, usually caused by significant exposure to noxious particles or gases. Smoking is an important risk factor but what is often less emphasized is the role of environmental pollution and occupational exposures as major risk factors. Even though cigarette smoke is harmful what is often ignored is the fact that persistent high-level exposure to polluted air is equivalent to smoking 10 to 15 cigarettes a day and air pollution causes more premature death than tobacco smoke in India. Therefore, it is not surprising that for one with a weak chest, even mild exposure to highly polluted air is sufficient to precipitate an acute respiratory emergency.

The prevalence of COPD is on the rise, affecting about 12 per cent of the global population with more than 3 million annual deaths and is associated with a high incidence of serious co-morbidities that are linked to air pollution and chronic smoking such as heart disease, musculoskeletal disorders, malignancy, anxiety and depression. Though it is commonly seen in middle-aged and elderly smokers, even non-smokers including women and children are affected especially those who live in congested and ill-ventilated dwellings.

The problem due to COPD is acute in low- and middle-income countries (LMIC) that account for 80 per cent of global deaths and the indoor air pollution due to coal or biomass fuel such as wood, animal dung and crop residue that are used for cooking and heating remaining the major risk factor.

Unfortunately, the diagnosis of COPD is often missed in the early stages of the disease as most affected remain relatively asymptomatic and early respiratory symptoms are often ignored by the patient. Advanced COPD is difficult to treat and an acute exacerbation is associated with a high risk of death and the only treatment, lung transplantation is extremely difficult to get. Despite many advances in the management of COPD, the only intervention that works favourably for the patient is smoking cessation and breathing unpolluted air that is colourless, odourless and tasteless with life-giving oxygen in the right amount to rejuvenate both the body and the mind. There is no doubt – prevention is key and avoiding risk factors, regular medication and rehabilitation are vital to maintaining the quality of life of the affected ones. The burden on health care and the costs involved in the management of COPD is huge that even the most advanced countries just cannot afford.

Experts know the adverse impact of air pollution and climate change on human health and disease, yet there is no full-proof solution in hand to replace highly polluting conventional energy with sustainable green energy and the global measures taken so far in this regard are grossly inadequate to reduce toxic emissions. World health organization’s action plan to promote clean and safe intervention for COPD prevention by clean household energy solutions toolkit (CHEST) can only succeed in realizing the mission with the collective will of all stakeholders.

Time is running out and the Conferences of the Parties (COP) to the climate change during the 26th annual conference this year have agreed to cut down CO2 and methane emissions, to phase- out subsidies on fossil fuel, to stop deforestation and to switch over to green energy sources to prevent the climate catastrophe. Breathing pure air, is a fundamental right of each and every creature, that cannot be wished away by cosmetic changes and concrete preventive actions should begin straight away.